Atherosclerosis Risk: Psoriasis Stronger Predictor Than Diabetes

Tara Haelle

August 25, 2016

Individuals with psoriasis have high rates of subclinical atherosclerosis based on their increased coronary artery calcium (CAC) scores, similar to those of patients with type 2 diabetes, according to a study published online August 24 in JAMA Dermatology.

In fact, having moderate to severe psoriasis more strongly predicted coronary calcification than having type 2 diabetes, the findings revealed, although cardiovascular risk factor profiles were similar among both patients with psoriasis and patients with type 2 diabetes. Severe coronary calcification was approximately five times more common in patients with psoriasis or type 2 diabetes compared with healthy control participants.

"Our findings are certainly intriguing given the fact that our patients were relatively young, with most having their moderate to severe cutaneous disease under good therapeutic control," write Bobbak Mansouri, MD, from Baylor University Medical Center, Dallas, Texas, and colleagues.

"However, the relative presence of moderate to severe psoriasis revealed greater strength in CAC assessment than type 2 diabetes, independent of the effect of known cardiovascular and cardiometabolic risk factors. The attenuation of the association between type 2 diabetes and CAC when adjusted for [body mass index] was not observed in psoriasis, suggesting that CAC may be mediated, in part, by adiposity in type 2 diabetes."

The researchers compared CAC scores among 387 individuals recruited from three outpatient clinics: 129 patients with psoriasis (93.0% with plaque-type psoriasis) and no type 2 diabetes, 129 patients with type 2 diabetes and no psoriasis or other inflammatory diseases, and 129 sex- and age-matched healthy individuals without psoriasis, type 2 diabetes, or other inflammatory diseases. More than 90% of the participants in each of the three groups were white, and the mean age was 51 or 52 years in all three groups. None of the participants had a history of coronary heart disease.

Hypertension prevalence was highest in the type 2 diabetes group, at 55.0%, compared with 38.0% in the psoriasis group. Similarly, mean waist circumference was greater in the type 2 diabetes group (108.0 cm) than in the psoriasis group (99.75 cm). Dyslipidemia prevalence, however, was more common among the patients with psoriasis, at 82.9% vs 62.8% among the patients with type 2 diabetes. Median triglyceride levels were 100 mg/dL in the psoriasis group and 132 mg/dL in the type 2 diabetes group.

CAC scores were higher in both the psoriasis and type 2 diabetes groups compared with in the healthy controls. The greater the number of traditional cardiovascular risk factors patients with psoriasis had, the higher their CAC score was, and a similar pattern appeared among those with type 2 diabetes.

However, correlations between the CAC and other cardiovascular and cardiometabolic risk factors were stronger among those with psoriasis than among those with type 2 diabetes. This finding was true for the risk factors of hypertension, metabolic syndrome, waist circumference, systolic and diastolic blood pressure, 10-year risk from the Framingham Risk Score, high-density lipoprotein cholesterol levels, and blood glucose levels.

In contrast, the patients with type 2 diabetes showed stronger correlations between CAC scores and current smoking, triglycerides, regular exercise, and very low low-density lipoprotein cholesterol levels.

The researchers then adjusted their findings for age, sex, cardiovascular risk factors, cardiometabolic risk factors, and medication use and found that the association between CAC and psoriasis was similar to that of CAC and type 2 diabetes. Further, patients with psoriasis had 2.35 greater odds of having any CAC, after adjusting for confounders, than healthy individuals without psoriasis or with type 2 diabetes (odds ratio [OR], 2.35; 95% confidence interval [CI], 1.12 - 4.94). However, no statistically significant increased odds existed with type 2 diabetes after adjusting for body mass index (OR, 2.18; 95% CI, 0.75 - 6.35).

"Psoriasis and type 2 diabetes share similar cardiovascular risk profiles, which may predispose patients to developing coronary atherosclerosis at a relatively young age," the authors conclude. "These findings warrant early cardiovascular risk assessment and aggressive risk factor modification in those with moderate to severe psoriasis."

The research was funded by the Baylor Heart and Vascular Institute Cardiovascular Research Review Committee, the Jack and Jane Hamilton Cardiovascular Research Fund, and the National Institutes of Health. Three authors reported financial relationships of some kind with at least some of the following: Abbott Laboratories, AbbVie, Amgen, Aqua, Astellas Pharma US Inc, Celgene, Centocor Ortho Biotech Inc, Galderma Laboratories LP, Lilly, Medimetriks, Novartis, Pfizer, Regeneron-Sanofi, UCB, and Warner Chilcott.

JAMA Dermatol. Published online August 24, 2016. Full text

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